Calculate your tax savings

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By completing the following information, you can calculate your annual reimbursable expenses.

Select Your Annual Income

Select Your Pay Cycle

Insurance Premiums (only if payroll deducted)
  Health Insurance $
Group Term Life Insurance $
Disability coverage $
Vision and/or Dental Insurance $
Other $
Total $

Healthcare Expenses (estimated)
Doctor visits and co-pays $
Deductibles $
Prescription drugs $
Weight-loss programs
   (associated with a specific disease).		 $
Prescribed medical supplies/equipment $
Travel to doctor or hospital $
Eye exams & surgery $
Glasses/contacts/solutions $
Dental checkups $
Fillings/crowns $
Orthodontia $
Chiropractic $
Psychiatric or psychologist's fees $
Other $
Total $

Dependent Care Expenses (estimated)
Children $
Adults $
Total $

Adoption Expenses (estimated)
Attorney fees $
Court costs $
Legal adoption fees $
Other $
Total $

Transportation and Parking Expenses for Travel to and from Work (estimated)
Bus or transit pass $
Token or fare card $
Voucher for mass transit $
Parking located near place of employment $
Parking located from which you
take mass transit or carpool		 $
Vanpooling expenses $
Other $
Total $

Estimated Annual Expenses and Tax Savings
Total Insurance Premiums $

Less HRA Contributions

If your plan offers an HRA, you will need to deduct the amount that would be eligible for reimbursement under your HRA.

 $
Total Healthcare Expenses $

Less HRA Contributions

If your plan offers an HRA, you will need to deduct the amount that would be eligible for reimbursement under your HRA.

 $
Total Dependent Care Expenses $
Total Adoption Expenses $
Total Transportation Expenses $
Total Annual Expenses $
Annual Tax Savings $
Estimated Savings 
Amount Per Paycheck		 $